Abstract 185: Declining Subarachnoid Hemorrhage Case-Fatality Rates in a Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jason Mackey ◽  
Kathleen Alwell ◽  
Jane C Khoury ◽  
Charles J Moomaw ◽  
Matthew L Flaherty ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Setting ◽  
Case Fatality ◽  
The United States ◽  
Population Based ◽  
Day Case ◽  
Physician Review ◽  
Time Period ◽  
Medical Advances ◽  
The Impact

Introduction: In the last few decades there have been several medical advances in the care of patients with subarachnoid hemorrhage (SAH). But few population-based studies (and none in the United States) have examined outcomes in the same population over time. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky (GCNK) region at least 20 years of age were identified using ICD-9 codes 430-436 and verified via study physician review in four distinct study periods. An incidence rate for each time period was calculated. Baseline characteristics, including demographics, risk factors, and functional status, were ascertained, along with hospital discharge modified Rankin score and all-cause 30- and 90-day case-fatality. Results: We identified 78 SAHs among residents of the GCNK region in 1988, 85 from 7/1993 to 6/1994, 95 in 1999, and 91 in 2005. The incidence of SAH in the four study periods (age-, race-, and sex-adjusted to the 2000 US population) was 9.4, 9.3, 10.0, and 9.0 per 100,000, respectively. Of the 349 SAHs in the study periods, 326 were diagnosed in an ED or hospital setting, while 23 were diagnosed on autopsy alone. All-cause 30- and 90-day case-fatality rates declined significantly from 1988 to 2005 ( Table ), even when all autopsy-alone cases were excluded. Conclusions: While the incidence of SAH remained stable in this population-based region, the 30-day and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, have likely led to reduced case-fatality. Future studies should explore the impact of specific factors related to improved case-fatality rates.

scholarly journals Assessing the Impact of Lifestyle Interventions on Diabetes Prevention in China: A Modeling Approach

2019 ◽  
Vol 16 (10) ◽  
pp. 1677 ◽  
Author(s):  
Linna Luo ◽  
Bowen Pang ◽  
Jian Chen ◽  
Yan Li ◽  
Xiaolei Xie
Keyword(s):  
Physical Activity ◽  
Peer Influence ◽  
Diabetes Prevention ◽  
The United States ◽  
Population Based ◽  
Agent Based ◽  
Individual Health ◽  
Time Period ◽  
Lower Body Weight ◽  
The Impact

China’s diabetes epidemic is getting worse. People with diabetes in China usually have a lower body weight and a different lifestyle profile compared to their counterparts in the United States (US). More and more evidence show that certain lifestyles can possibly be spread from person to person, leading some to propose considering social influence when establishing preventive policies. This study developed an innovative agent-based model of the diabetes epidemic for the Chinese population. Based on the risk factors and related complications of diabetes, the model captured individual health progression, quantitatively described the peer influence of certain lifestyles, and projected population health outcomes over a specific time period. We simulated several hypothetical interventions (i.e., improving diet, controlling smoking, improving physical activity) and assessed their impact on diabetes rates. We validated the model by comparing simulation results with external datasets. Our results showed that improving physical activity could result in the most significant decrease in diabetes prevalence compared to improving diet and controlling smoking. Our model can be used to inform policymakers on how the diabetes epidemic develops and help them compare different diabetes prevention programs in practice.

scholarly journals Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

2020 ◽  
pp. 1-6
Author(s):  
Enrico Giordan ◽  
Christopher S. Graffeo ◽  
Alejandro A. Rabinstein ◽  
Robert D. Brown ◽  
Walter A. Rocca ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Incidence Rate ◽  
Case Fatality Rate ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Fatality ◽  
Population Based ◽  
Fatality Rate ◽  
Olmsted County ◽  
Day Case ◽  
Incident Cases

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

scholarly journals Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Melissa C. MacKinnon ◽  
Scott A. McEwen ◽  
David L. Pearl ◽  
Outi Lyytikäinen ◽  
Gunnar Jacobsson ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Mortality Rate ◽  
Case Fatality ◽  
Population Based ◽  
Day Case ◽  
Fatality Risk ◽  
E Coli ◽  
Factors Associated ◽  
Case Fatality Risk ◽  
Age And Sex

Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019

Hand ◽  
2021 ◽  
pp. 155894472199080
Author(s):  
Danielle A Thornburg ◽  
Nikita Gupta ◽  
Nathan Chow ◽  
Jack Haglin ◽  
Shelley Noland
Keyword(s):  
Consumer Price Index ◽  
Hand Surgery ◽  
The United States ◽  
Medicare Reimbursement ◽  
Reimbursement Rate ◽  
Time Period ◽  
Long Term Trends ◽  
Fee Schedule ◽  
Procedure Codes ◽  
The Impact

Background: Medicare reimbursement trends across multiple surgical subspecialties have been analyzed; however, little has been reported regarding the long-term trends in reimbursement of hand surgery procedures. The aim of this study is to analyze trends in Medicare reimbursement for commonly performed hand surgeries. Methods: Using the Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File, we determined the 20 hand surgery procedure codes most commonly billed to Medicare in 2016. Reimbursement rates were collected and analyzed for each code from The Physician Fee Schedule Look-Up Tool for years 2000 to 2019. We compared the change in reimbursement rate for each procedure to the rate of inflation in US dollars, using the Consumer Price Index (CPI) over the same time period. Results: The reimbursement rate for each procedure increased on average by 13.9% during the study period while the United States CPI increased significantly more by 46.7% ( P < .0001). When all reimbursement data were adjusted for inflation to 2019 dollars, the average reimbursement for all included procedures in this study decreased by 22.6% from 2000 to 2019. The average adjusted reimbursement rate for all procedures decreased by 21.92% from 2000 to 2009 and decreased by 0.86% on average from 2009 to 2019 ( P < .0001). Conclusion: When adjusted for inflation, Medicare reimbursement for hand surgery has steadily decreased over the past 20 years. It will be important to consider the implications of these trends when evaluating healthcare policies and the impact this has on access to hand surgery.

scholarly journals Firework-related injuries treated at emergency departments in the United States during the COVID-19 pandemic in 2020 compared to 2018–2019

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Nathan Maassel ◽  
Abbie Saccary ◽  
Daniel Solomon ◽  
David Stitelman ◽  
Yunshan Xu ◽  
...  
Keyword(s):  
United States ◽  
Census Data ◽  
The United States ◽  
Population Based ◽  
Emergency Department Visits ◽  
Consumer Product Safety Commission ◽  
Injury Surveillance System ◽  
Time Period ◽  
National Estimates ◽  
Us Census

Abstract Background Despite a national decrease in emergency department visits in the United States during the first 10 months of the pandemic, preliminary Consumer Product Safety Commission data indicate increased firework-related injuries. We hypothesized an increase in firework-related injuries during 2020 compared to years prior related to a corresponding increase in consumer firework sales. Methods The National Electronic Injury Surveillance System (NEISS) was queried from 2018 to 2020 for cases with product codes 1313 (firework injury) and narratives containing “fireworks”. Population-based national estimates were calculated using US Census data, then compared across the three years of study inclusion. Patient demographic and available injury information was also tracked and compared across the three years. Firework sales data obtained from the American Pyrotechnics Association were determined for the same time period to examine trends in consumption. Results There were 935 firework-related injuries reported to the NEISS from 2018 to 2020, 47% of which occurred during 2020. National estimates for monthly injuries per million were 1.6 times greater in 2020 compared to 2019 (p < 0.0001) with no difference between 2018 and 2019 (p = 0.38). The same results were found when the month of July was excluded. Firework consumption in 2020 was 1.5 times greater than 2019 or 2018, with a 55% increase in consumer fireworks and 22% decrease in professional fireworks sales. Conclusions Firework-related injures saw a substantial increase in 2020 compared to the two years prior, corroborated by a proportional increase in consumer firework sales. Increased incidence of firework-related injuries was detected even with the exclusion of the month of July, suggesting that the COVID-19 pandemic may have impacted firework epidemiology more broadly than US Independence Day celebrations.

A Population-Based Study of the Incidence and Case Fatality of Non-aneurysmal Subarachnoid Hemorrhage

2014 ◽  
Vol 22 (3) ◽  
pp. 409-413 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Nauman Jahangir ◽  
Mushtaq H. Qureshi ◽  
Archie Defillo ◽  
Ahmed A. Malik ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Fatality ◽  
Population Based ◽  
Population Based Study

Abstract 3225: Gross Domestic Product and Health Expenditure Associated with Incidence, 30-Day Fatality and Age at Stroke Onset: A Systematic Review

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Luciano Sposato ◽  
Gustavo Saposnik
Keyword(s):  
Socioeconomic Status ◽  
Gross Domestic Product ◽  
Purchasing Power Parity ◽  
Case Fatality ◽  
Population Based ◽  
Stroke Onset ◽  
Power Parity ◽  
Day Case ◽  
Scatter Plots ◽  
Per Capita

Background: Differences in definitions of socioeconomic status (SES) and between study designs hinder their comparability across countries. We aimed to analyze the correlation of three widely used macro-SES indicators with stroke incidence and age at stroke onset. Methods: We selected population-based studies reporting incident stroke risk and/or 30-day case fatality according to pre-specified criteria. We used three macro-SES indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity (PPP-aGDP), total health expenditures per capita at purchasing power parity (PPP-aTHE) and unemployment rate. We used two-tailed Spearman’s test and scatter-plots for analyzing the correlation of each macro-SES indicator with incident risk of stroke, 30-day case fatality rates, proportion of hemorrhagic strokes and age at stroke onset. Results: Twenty-three manuscripts comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using standardized World Health Organization World population, 30-day case fatality rates, proportion of hemorrhagic strokes and age at stroke onset were associated to lower PPP-aGDP and PPP-aTHE ( Table 1 and Figures 2 and 3). There was no correlation between unemployment rates and outcome measures. Table 1. Correlation Analyses of Macro-Indicators of Socioeconomic Status Figures 1. Scatter Plots for PPP-aGDP Figures 2. Scatter Plots for PPP-aTHE Conclusions: Lower PPP-aGDP and PPP-aTHE were associated with higher incident risk of stroke, higher case fatality, greater proportion of hemorrhagic strokes and lower age at stroke onset. As a result, these macro-SES indicators may be used as proxy measures of quality of primary prevention and acute care and considered as important factors for developing strategies aimed at improving worldwide stroke care.

The Impact of the Use of Cross-Border Compensation Peers: The Case of Canadian Companies Using U.S. Peers

2020 ◽  
pp. 0148558X2093012
Author(s):  
Steven Balsam ◽  
Hong Fan ◽  
Amin Mawani ◽  
Daqun Zhang
Keyword(s):  
Ceo Compensation ◽  
Peer Groups ◽  
The United States ◽  
Stage Model ◽  
Change Models ◽  
Cross Border ◽  
Compensation Package ◽  
Time Period ◽  
Market Factors ◽  
The Impact

CEO compensation in Canada is significantly lower than that in the United States. In this article, we examine the choice of, and impact on Canadian CEO Compensation, using U.S. firms in their compensation peer groups. Using a two-stage model to control for endogeneity, while we find the choice of peers associated with labor market factors, we still find that the use of U.S. peers positively associated with higher Canadian CEO compensation. This finding is after controlling for the traditional determinants of CEO compensation, as well as use of domestic peers. While this result holds for all components of the compensation package, we also find that having U.S. peers is associated with a greater proportion of equity in the compensation package. Our results are robust to various formulations including change models and using an earlier time period when peer disclosure was voluntary.

scholarly journals Stroke Incidence and Case Fatality According to Rural or Urban Residence

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2661-2667 ◽  
Author(s):  
Olivier Grimaud ◽  
Yacine Lachkhem ◽  
Fei Gao ◽  
Cindy Padilla ◽  
Mélanie Bertin ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Access ◽  
Case Fatality ◽  
The United States ◽  
Stroke Severity ◽  
Day Case ◽  
Stroke Incidence ◽  
Stroke Registry ◽  
Stroke Type

Background and Purpose— Recent findings suggest that in the United States, stroke incidence is higher in rural than in urban areas. Similar analyses in other high-income countries are scarce with conflicting results. In 2008, the Brest Stroke Registry was started in western France, an area that includes about 366 000 individuals living in various urban and rural settings. Methods— All new patients with stroke included in the Brest Stroke Registry from 2008 to 2013 were classified as residing in town centers, suburbs, isolated towns, or rural areas. Poisson regression was used to analyze stroke incidence and 30-day case fatality variations in the 4 different residence categories. Models with case fatality as outcome were adjusted for age, stroke type, and stroke severity. Results— In total, 3854 incident stroke cases (n=2039 women, 53%) were identified during the study period. Demographic and socio-economic characteristics and primary healthcare access indicators were significantly different among the 4 residence categories. Patterns of risk factors, stroke type, and severity were comparable among residence categories in both sexes. Age-standardized stroke rates varied from 2.90 per thousand (95% CI, 2.59–3.21) in suburbs to 3.35 (95% CI, 2.98–3.73) in rural areas for men, and from 2.14 (95% CI, 2.00–2.28) in town centers to 2.34 (95% CI, 2.12–2.57) in suburbs for women. Regression models suggested that among men, stroke incidence was significantly lower in suburbs than in town centers (incidence rate ratio =0.87; 95% CI, 0.77–0.99). Case fatality risk was comparable across urban categories but lower in rural patients (relative risk versus town centers: 0.76; 95% CI, 0.60–0.96). Conclusions— Stroke incidence was comparable, and the 30-day case fatality only slightly varied in the 4 residence categories despite widely different socio-demographic features covered by the Brest Stroke Registry.

Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Part II: management and surgical outcome

2000 ◽  
Vol 93 (6) ◽  
pp. 967-975 ◽  
Author(s):  
Tetsuji Inagawa ◽  
Masaaki Shibukawa ◽  
Futoshi Inokuchi ◽  
Yoshio Tokuda ◽  
Yoshikazu Okada ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Survival Rates ◽  
Case Fatality ◽  
Epidemiological Studies ◽  
Day Case ◽  
Content Type ◽  
Gcs Score ◽  
Fine Print

Object. The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japan.Methods. During 1991 through 1996, 267 patients with ICH and 123 with SAH were treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma removal by open craniotomy or suboccipital craniectomy and 34 underwent stereotactic evacuation of the hematoma, whereas aneurysm clipping was performed in 71 of the 123 patients with SAH; operability rates were thus 22% for ICH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73% and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30-day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.0262), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case-fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding, and midline shifting, whereas those for 2-year survival were the GCS score, age, rebleeding, and hematoma volume. In patients with SAH, the most important determinants of 30-day case-fatality rates were the GCS score and age, whereas only the GCS score had a significant impact on 2-year survival.Conclusions. The overall survival rates for patients with ICH or SAH in Izumo were more favorable than those in previously published epidemiological studies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.

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